Factors associated with the implementation and full use of a nationwide health information technology system [article]

Tamara L. Box
To date, no study has followed the complete diffusion of health IT across a large, nationwide health care system and evaluated key factors at specific times. This observational study evaluated the successful nationwide implementation of the Department of Veterans Affairs (VA) Clinical Assessment, Reporting, and Tracking system (CART) Program in all 75 VA cardiac catheterization laboratory hospitals, from first contact with each hospital, through technical installation, and concluding with full
more » ... linical use. The aims of this study were to: (1) evaluate variation in the durations of the chronological stages of implementation and assess the hospital-specific characteristics associated with the time required to achieve full implementation; (2) identify facilitators and barriers associated with implementation; and (3) explore the association of key factors with the time required to complete full implementation and also two time periods within the implementation process. The diffusion of CART implementation followed a pattern typical for innovations. Most stages of implementation varied little in duration among hospitals; however, there was significantly higher variation in the final stage of implementation, Clinical Use, which began after training and concluded with full use of CART. In a survey of clinical iv champions, integration of CART with the EHR, senior leadership endorsement, and the desire to improve quality were the top three facilitators noted for implementation. Contentment with current processes and VA technical support were among the top barriers noted. In multivariable analyses, research potential using CART data and CART Program technical support were key facilitators associated with significantly faster implementation times; conversely, contentment and privacy and security regulations were barriers associated with slower implementation times. Finally, initiation of implementation after endorsement of CART by senior leadership was associated with significantly faster times to install CART, and faster implementation times overall. The results of this study reinforce that successful health IT implementation does not end with technical installation and training, and must support clinical use as part of routine care delivery. In addition, key factors may be important at various time points to support successful diffusion. Organizations should be mindful of motivational factors to move beyond installation of health IT to full use. The form and content of this abstract are approved. I recommend its publication. Approved: John S. Rumsfeld v DEDICATION This work is dedicated to my parents, Robert and Linda Box, who, through their love, support, and example made this imaginable, and to Sarah Lewis, who makes the sun shine. vi ACKNOWLEDGEMENTS First and foremost, I am grateful to Drs. Ross, Rumsfeld, Grunwald, Ho, and Lezotte for their time, support, and expertise. I am incredibly honored and equally humbled to have been guided by such an esteemed group. Dr. Steve Ross, thank you, especially, for pushing me and sticking by me through this long process. Dr. Gary Grunwald, you have been such a tremendous support from the very beginning -thanks for always finding time to meet and the gentle nudges you gave along the way to keep me on the right path. Dr. Mike Ho, thanks for being one of the very first to introduce me to CART -way back when it was just an idea on a spreadsheet -and for your always thoughtful and thorough reviews. Dr. Denny Lezotte, thank you for helping me throughout my graduate studies, including my first publication as a graduate student, and for your support during this thesis process. And Dr. Heather Haugen, thank you for being a friend, mentor, and honorary committee member. Dr. John Rumsfeld, I do not know how to sufficiently thank you for everything you have done for me. Thank you for always knowing when I needed a big push or when I just needed a little encouragement instead. You have quietly taught so many of us about clinical science, leadership, management, and life. It is both a joy and an honor to be mentored by you. I also want to thank my Duke mentors, especially Dr. Eugene Oddone, Dr. Sheri Keitz, and Dr. Elizabeth (Jody) Clipp. Thank you for embracing my love for new technologies and encouraging me to apply them to clinical science, even before health vii IT was a field. Gene, thanks for being such a stalwart supporter over the years and introducing me to Colorado. Sheri, every time I prepare a presentation, I think of your first Grand Rounds and your boundless enthusiasm for presenting data in such a way that it captivates everyone in the room; I have always tried to follow your example. And Jody, I truly wish you were still with us and I could wander into your office and tell you I finally finished. This acknowledgement section would not be complete without you in it. Your fierce passion for research was only surpassed by your devotion to your family, and your mentorship left an indelible mark on me and so many others; thank you. To my VA and CART colleagues -especially Dr.
doi:10.25677/ca03-rd71 fatcat:sja6x4bu4nb6josgulbrzigicy